A Prescription For Millions

Public-health departments nationwide are working to comply with the Centers for Disease Control and Prevention's guidelines for a national electronic health-data surveillance and response system to identify bioterrorist attacks and outbreaks of naturally occurring diseases. The CDC is giving states money either to develop their own systems or to buy packaged offerings. It's up to states and local agencies how to spend their cut of the $940 million budgeted in 2002 to fortify health services.

Since Sept. 11, and especially since the anthrax scare last fall, the need for early-detection of bioterrorism and other public-health crises has escalated. "It can take a week to confirm a lab test, but we needed something that could identify a potential health problem within 24 hours," says Jordan Lewis, director of Environmental Health & Epidemiology at the Hillsborough County, Fla., department of health.

Surveillance systems alert public-health and other officials as early as possible to any aberration in the data on patients being treated or seen by emergency workers, hospitals, or other health-care providers. Aberrations could include unusual symptoms or combinations of symptoms for the season or geographic region, or an unusual number of patients complaining of certain symptoms.

The systems collect information about patients. Patient identities are stripped from the data for privacy, but demographics such as age and sex are retained. The systems compare data with historical information to look for unusual patterns. If an aberration is detected, health-care providers or public-health officials are alerted electronically.

The military has worked on this sort of system for years. The Lightweight Epidemiology Advanced Detection & Emergency Response System (Leaders) was launched in 1993 by the Defense Advanced Research Project Agency. It's now being used in civilian health care, including events such as President George W. Bush's inauguration. Data on illnesses at an event is collected for analysis.

The technology used in Leaders comes from several vendors, including Compressus, EYT (formerly Ernst & Young Technologies), Idaho Technologies, Oracle, and ScenPro. It uses a Web-based application that lets health-care workers input information on a patient's symptoms. The data is sent to a server where it's mined for aberrations.

The system lets officials see where unusual symptoms are being reported through an application that can display a map of a city or region, with different colors indicating possible problem areas.

Among the first civilian uses of the Leaders system was as a medical-surveillance system for five hospitals in the Tampa, Fla., area during last year's Super Bowl. Since then, Hillsborough County's public-health department has adopted it to supplement a manual process.

Doctors at nine hospitals and emergency response workers now use the Hillsborough electronic system by inputting data at a secure Web site about patients' demographics and symptoms during or soon after an exam. The data is sent to a Leaders data-mining system in Virginia, which downloads the data to Excel spreadsheets. Hillsborough runs that data through SAS Institute Inc. statistical programs, identifying aberrations and sending warnings.

Leaders is also being expanded for military use. The Air Force is creating a more automated system that will pull data from military hospitals' lab, pharmacy, and radiology systems, says Lt. Col. Steven Bell, Leaders program director for the office of the Air Force Surgeon General. That system will analyze data collected about patient symptoms and will look for unusual patterns in lab tests and drugs physicians order that might indicate a biological attack.

"The challenge is creating the algorithms with help from subject-matter experts" to identify or set guidelines for the aberrations, Bell says. For instance, pharmacies and labs would help develop guidelines for the typical number of antibiotic orders in May, and the system will send an alert if that number spikes. Initial use of the expanded system will be at two military hospitals this year. The plan is to expand the enhanced system throughout the Defense Department in 2003 or 2004, Bell says.

One goal is to have lab, pharmacy, and radiology data sent automatically to the system without extra work by health-care personnel, Bell says. Interfaces between the Leaders software and hospital systems will facilitate this. This presents a development challenge, Bell says, but the military has an advantage over many civilian health-care providers, because most military hospitals run the same pharmacy, lab, and radiology systems, so interface development is easier.

"There's strength in numbers," Bell says. "The bigger the population and the more data that's available to be mined, the better."